title: Adult out-of-hospital cardiac arrest based on chain of survival in Taoyuan County, northern Taiwan.
abstract: BACKGROUND
  Most out-of-hospital cardiac arrest (OHCA) studies have been conducted in developed countries or metropolitan areas, and few in developing countries or rural areas.
  
  
  OBJECTIVE
  The aims of this study were to determine the weak links in the chain of survival and to estimate the outcomes of OHCA patients in Taoyuan, a nonmetropolitan area in Taiwan.
  
  
  METHODS
  A retrospective review and analysis of OHCA data was conducted. The three outcomes were whether a return of spontaneous circulation (ROSC) was achieved, whether the patient survived to admission, or whether the patient survived to hospital discharge.
  
  
  RESULTS
  From April to December 2008, 1048 OHCA patients were resuscitated, and 712 (67.9%) adult cardiac patients were used in this study. Among these 712 patients, 17.8% achieved ROSC (95% confidence interval [CI] 15.2-20.8%), 16.3% survived to admission (95% CI 13.6-19.0%), and 1.4% survived to discharge (95% CI 0.5-2.3%). Factors significantly associated with the three outcomes were witness status, response time to emergency medical services, and whether the patient had a shockable rhythm. Bystander cardiopulmonary resuscitation (CPR) did not add a notable benefit to the outcomes of OHCA.
  
  
  CONCLUSIONS
  The survival rate of OHCA patients in nonmetropolitan Taiwan was very low (1.4%). Lower witnessed rate, lower bystander CPR rate, and longer response interval in remote areas are the main causes of inferior survival rate.
authors.affiliation: Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Taiwan.
authors.forename: Chan-Wei
authors.initials: CW
authors.lastname: Kuo
authors.affiliation: Biostatistics Consulting Center, Department of Public Health, College of Medicine, Chang Gung University, Taiwan; Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taiwan.
authors.forename: Lai-Chu
authors.initials: LC
authors.lastname: See
authors.affiliation: Biostatistics Consulting Center, Department of Public Health, College of Medicine, Chang Gung University, Taiwan.
authors.forename: Hui-Tzu
authors.initials: HT
authors.lastname: Tu
authors.affiliation: Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Taiwan.
authors.forename: Jih-Chang
authors.initials: JC
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000628:therapy; D016887:Cardiopulmonary Resuscitation; D047548:Defibrillators; D004554:Electric Countershock; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000628:therapy*; D010343:Patient Admission; D010351:Patient Discharge; D012189:Retrospective Studies; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult
keywords: Taiwan; out-of-hospital cardiac arrest (OHCA); return of spontaneous circulation (ROSC); survival